Healthcare Provider Details

I. General information

NPI: 1497743082
Provider Name (Legal Business Name): LARRY ROY KALP D. M. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 E MAIN ST
EVERETT PA
15537-1259
US

IV. Provider business mailing address

109 E MAIN ST
EVERETT PA
15537-1259
US

V. Phone/Fax

Practice location:
  • Phone: 814-652-6050
  • Fax: 814-652-9183
Mailing address:
  • Phone: 814-652-6050
  • Fax: 814-652-9183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS016963
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: